Quality assessment of information about medications in primary care electronic patient record (EPR) systems

Background Many different brands of primary care electronic patient record (EPR) software are available to general practitioners (GPs). Their ability to support GPs in improving prescribing varies greatly. Objective To assess, using a ten-item tool, the quality of drug information provided by EPR software to support the appropriateness of prescriptions and to propose a list of quality standards for this type of application. Methods The eight EPR programmes most used in general practice in Italy were assessed by a multidisciplinary team using the ten-item tool. The tool evaluated information on single drugs and drug safety and information on prescription rules in force. Results Out of eight EPR programmes assessed, none scored more than 55% of the maximum possible score. Two achieved scores higher than 50%, one scored 48%, four ranged from 32% to 39% and one obtained 22%. Information on drug safety, such as the ability to detect interactions, to monitor laboratory parameters or to get updated information on drug safety was particularly limited. None of the eight EPR programmes contained drug information for patients, but two of them contained drug advertising. Conclusions This project highlighted the poor quality of drug information provided by these EPR programmes. The ten-item tool seems suitable for assessing their quality. Based on this analysis, we have proposed a set of ten quality standards for prescribing software

Quality assessment of information about medications in primary care electronic patient record (EPR) systems

Background Many different brands of primary care electronic patient record (EPR) software are available to general practitioners (GPs). Their ability to support GPs in improving prescribing varies greatly. Objective To assess, using a ten-item tool, the quality of drug information provided by EPR software to support the appropriateness of prescriptions and to propose a list of quality standards for this type of application. Methods The eight EPR programmes most used in general practice in Italy were assessed by a multidisciplinary team using the ten-item tool. The tool evaluated information on single drugs and drug safety and information on prescription rules in force. Results Out of eight EPR programmes assessed, none scored more than 55% of the maximum possible score. Two achieved scores higher than 50%, one scored 48%, four ranged from 32% to 39% and one obtained 22%. Information on drug safety, such as the ability to detect interactions, to monitor laboratory parameters or to get updated information on drug safety was particularly limited. None of the eight EPR programmes contained drug information for patients, but two of them contained drug advertising. Conclusions This project highlighted the poor quality of drug information provided by these EPR programmes. The ten-item tool seems suitable for assessing their quality. Based on this analysis, we have proposed a set of ten quality standards for prescribing software

Aspetti igienico-sanitari e nutrizionali di un nuovo alimento: il latte d'asina

The study was carried out with the aim of widening the knowledge about the hygienical quality and nutritional properties of donkey's milk. Six lactating donkeys reared in Padua's and Pordenone's area in semi-extensive conditions were investigated. Individual milk samples were collected every week during different stages of lactation from October 2006 to May 2007 and then analyzed

Problematiche relative all\u2019innesco delle frane superficiali

Il saper riconoscere l\u2019instabilit\ue0 superficiale dei versanti, dalla quale originano colate detritiche o di fango, spesso comprese nel pi\uf9 generico termine di frane superficiali, risulta determinante nella definizione delle aree soggette a rischio idrogeologico e necessita di studi volti ad inquadrare le dinamiche idrologiche e meccaniche che determinano il collasso. Nella nota sono riportate le prime evidenze delle esperienze svolte su di un pendio strumentato messo a punto per indagare l\u2019innesco di movimenti superficiali conseguenti ad una precipitazione intensa su di un terreno incoerente

Full-scale physical model of landslide triggering

Landslide triggering induced by high-intensity rainfall infiltration in hillslopes is a complex phenomenon that involves hydrological processes operating at different spatio-temporal scales. Empirical methods give rough information about landslide-prone areas, without investigating the theoretical framework needed to achieve an in-depth understanding of the involved physical processes. In this study, we tackle this issue through physical experiments developed in an artificial hillslope realized in the Department of Civil, Environmental and Architectural Engineering of the University of Padua. The structure consists of a reinforced concrete box containing a soil prism with the following maximum dimensions: 3.5 m high, 6 m long, and 2 m wide. In order to analyze and examine the triggered failure state, the experiments are carried out with intensive monitoring of pore water pressure and moisture content response. Subsurface monitoring instruments are installed at several locations and depths to measure downward infiltration and/or a rising groundwater table. We measure the unsaturated soil water pressure as well as positive pore pressures preceding failure in each experiments with six tensiometers. The volumetric water content is determined through six Time Domain Reflectometry probes. Two pressure transducers are located in observation wells to determine the position of the water table in time. Two stream gauges are positioned at the toeslope, for measuring both runoff and subsurface outflow. All data are collected and recorded by an acquisition data system from Campbell Scientific. The artificial hillslope is characterized by well-known and controlled conditions, which are designed to reproduce an ideal set-up susceptible to heavy rainfall landslide. The hydrologic forcing is generated by a rainfall simulator realized with nozzles from Sprying System and. specifically designed to produce a spatially uniform rainfall of intensity ranging from 50 to 150 mm/h. The aim of our experiments is to reproduce the instability trigger that occurs in saturated or partially unsaturated conditions depending on the specific characteristics of the soil and its initial conditions; the retention curve of fine sand and the initial porosity are taken into account to highlight the hydrological condition of the surface layer during the trigger occurrence. Through our experimental setup we can investigate the succession of phases and their magnitude that cause the landslide trigger, in order to understand the instability mechanism that heavy rainfall can induce in fine sandy hillslopes. Particular attention is given on the role of water pressure head, not only with respect to the violation of Coulomb failure within a sloping soil, but also with respect to the subsequent deformation that involves the upper hillslope layers. In particular, we report here on the characterization of the sandy terrain used in the experiments and the preliminary results, together with a first discussion of the observed data

Calibration of water content reflectometer sensors with a large soil sample

In situ measurement of soil water content is of fundamental importance in vadose zone processes. While time domain reflectometry (TDR) is a universally accepted technique, having been developed since the 1980s, water content reflectometer (WCR) is still a relatively new technique and does not hold a similar background. The main goal of this study was to establish an accurate calibration curve for WCR sensors to be installed in an artificial hillslope designed to study the triggering of shallow landslides. Therefore, high accuracy calibration at the high end of the water content range and for large soil volumes was necessary. An experimental device was specifically designed to provide a calibration procedure for a soil control volume commensurate with the application scale of the probes in the hillslope. A large box container (60 by 50 by 60 cm) was used, inside which three WCR probes and three tensiometers were arranged. A drip emitter produced assigned flow rates, while a load cell at the base measured the time evolution of the infiltrated water mass. Water content was evaluated at approximately steady-state flow conditions for infiltration and drainage experiments, performed with varying degrees of compaction to detect the effect of the porosity on the calibration curve. The experimental results suggest a calibration relationship linearly depending not only on the WCR output signal but also on the porosity. In addition, the calibration curve provided by the manufacturer significantly underestimates the soil water content, with a range of predicted volumetric water content values between 3 and 35%, compared with actual values varying between 19 and 61%

Design and performance of a nozzle-type rainfall simulator for landslide triggering experiments

Rainfall simulators represent a widespread tool for studying hydrologic processes involving interactions of rainwater with soils, such as soil erosion, overland flow generation, and infiltration. Nevertheless, researchers must often develop devices suiting their particular needs, due to a lack of a standard design. In this case, a rainfall simulator was needed for the production of heavy rainfall, to be applied for the study of infiltration dynamics and landslide triggering on an artificial hillslope with a planar size of 2 m by 6 m. Therefore, the goal of this study was to design and test a rainfall simulator characterized by the following main properties: i) range of rainfall intensity varying from 50 to 150 mm/h, ii) spatial uniformity of the produced rain of at least 80%, and iii) limited impact energy on the soil in order to avoid surface erosion, which can alter the infiltration processes responsible for the landslide triggering. To achieve these objectives, three nozzles were first individually tested, in order to identify the main variables affecting their functioning and performance. Further investigations were then carried out to find the best configuration of nozzles for the final version of the full-scale rainfall simulator and test its performance. Depending on the desired rainfall range, four different configurations of nozzles, distinguished by the number of active nozzles and their location, were chosen to cover the required intensity interval. The simulator performance was assessed via the Christiansen uniformity coefficient (CU), which resulted in values larger than 80%. The drop size distribution was assessed by means of the oil method and used for the calibration of a numerical model aimed at estimating the impact energy of the drops falling onto the soil. This allowed for the assessment of the rainfall potential erosion and its spatial distribution, highlighting that the surface erosion generated by the proposed rainfall simulator is limited, corresponding to the kinetic energy exerted by natural rainfall rates of no more than 10 mm/h

Comparative Analysis of Kinematic Approximation and Richards Equation Models for Subsurface Flow on Complex Hillslopes

Generalized solutions for the kinematic wave equation for subsurface flow have recently been derived for hillslopes of arbitrary geometry by introducing two dimensionless geometric parameters \u3b1 and \u3b5 which define the hydrologic similarity between hillslopes with respect to their characteristic response (Norbiato and Borga, 2008). These solutions are derived by using a second order polynomial function to describe the bedrock slope and an exponential function to describe the variation of the width of the hillslope with hillslope distance. In this presentation we assess the behavior of this simple, one- dimensional model in comparison with a fully three-dimensional Richards equation model for a series of free drainage scenarios. For different values of saturated hydraulic conductivity, we specify the range of values of the two dimensionless geometric parameters \u3b1 and \u3b5 for which the generalized solution is valid. Special attention is given to the discretization and setup of the boundary and initial conditions

Numerical and physical modeling to assess landslide triggering induced by hydrological hillslope processes

Landslide triggering induced by high-intensity rainfall infiltration in hillslopes is a complex phenomenon that involves hydrological processes operating at different spatio-temporal scales. Empirical methods give useful information about landslide-prone areas and rainfall intensity and duration that generate slope failures, but they do not provide the theoretical framework needed to achieve an in-depth understanding of the involved physical processes. This fact limits the predictive use of these empirical methods, which are usually site-dependent and unable to assess the landslide hazard with respect to different land uses proposed for mitigation purposes. Depending on rainfall intensity, slope geometry, and soil hydraulic properties, the runoff/infiltration process controls water pressure changes in both the saturated and unsaturated zones, affecting the behavior of shear strength and seepage forces, and, as a consequence, the slope stability. In this study, we tackle the whole process by using both numerical and physical approaches, the former being developed to design (a priori) and analyze (a posteriori) a number of experiments carried out in an ad hoc designed artificial hillslope. The maximum height of the embankment, contained in a reinforced concrete box, is 3.5 m, with length of 6 m and width of 2 m, so that a 2:3 slope can be built. On each lateral side of the box, 50 openings closed with screw caps allow the insertion on properly chosen positions of the control instrumentation (6 tensiometers and 6 TDR sensors). The monitoring network, connected to an automatic acquisition system, is completed by two piezometers, one evaporimeter, and two stream gages able to evaluate both the surface runoff and subsurface contributions to the total outflow. The numerical tool we use is a distributed physically-based catchment simulator (CATHY, CATchment Hydrology) able to model both surface routing and subsurface flow in a coupled fashion. In order to demonstrate the effectiveness of the proposed physical and numerical investigation approach, we report on the arrangement of laboratory facilities (including the non-trivial design and building of the rainfall simulator system), the theoretical design of physical experiments, and a preliminary analysis of experimental evidence